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Published on: January 28, 2020
Peculiar angiographic predictors of impending left ventricular rupture after primary coronary angioplasty
Gianluca Rigatelli1, Paolo Cardaioli, Fabio Dell'Avvocata
1Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy. jackyheart@hotmail.com
Insights
Angiographic contrast dye persistence during primary percutaneous coronary intervention can predict left ventricular rupture. These findings aid in identifying high-risk patients for timely surgical intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Left ventricular rupture is a rare but often fatal complication of acute myocardial infarction.
- Predictive angiographic markers for impending left ventricular rupture have not been well-defined in the primary percutaneous coronary angioplasty era.
Purpose of the Study:
- To identify specific angiographic determinants that predict impending left ventricular rupture following primary percutaneous coronary angioplasty.
- To improve early detection and management of this critical complication.
Main Methods:
- Retrospective analysis of medical and angiographic records of 348 patients with acute myocardial infarction undergoing primary angioplasty.
- Independent review of coronary angiograms by two blinded observers searching for abnormal signs of impending left ventricular rupture.
Main Results:
- Left ventricular rupture occurred in 11 patients (3.16%), with 10 fatalities.
- Angiographic signs, specifically round-shaped contrast dye persistence, were observed in 10/11 cases of rupture.
- Logistic regression identified symptom onset time, cardiogenic shock, and contrast dye persistence as independent predictors of cardiac rupture.
Conclusions:
- Specific angiographic signs, such as contrast dye persistence, can indicate impending left ventricular rupture during primary coronary angioplasty.
- These findings can guide physicians in adopting targeted echocardiographic protocols and facilitate prompt surgical referral for high-risk patients.
Background:
Peculiar angiographic characteristics predictive of impending left ventricular rupture have not yet been described in primary percutaneous coronary angioplasty era. Our study is aimed to evaluate the existence of peculiar angiographic determinants of impending left ventricular rupture after primary percutaneous coronary angioplasty.
Methods:
We retrospectively analyzed medical and angiographic records of patients referred to our center for acute myocardial infarction (AMI) and submitted to primary angioplasty between 1st May 2005 and 30th September 2007. All the coronary angiograms and coronary angioplasties were reviewed by two independent observers blinded to the final outcome of the patients searching for any abnormal angiographic signs of impending left ventricular rupture.
Results:
The records of 348 patients (mean age, 76+/-25.8 years, 198 females) with AMI submitted to primary percutaneous coronary interventions (PCI) have been reviewed and analyzed. Left ventricular rupture occurred in 11 patients (3.16%): 10 of 11 patients died, whereas one survived to an inferoposterior left ventricular rupture conservatively managed with repeated pericardiocentesis and blood transfusions. The observers found in all 10/11 cases (2.87%) of left ventricular ruptures some angiographic signs of impending rupture such as round-shaped contrast persistence in the region of the rupture confirmed by autopsy or in the only one survivor by computed tomography. No similar images were detected on angiography of the remaining 337 patients (P<.001). Logistic regression analysis demonstrated that only long time that elapsed from symptoms onset, cardiogenic shock, and abnormal angiographic contrast dye persistence images were independent predictors of cardiac rupture.
Conclusion:
Angiographic signs of impending ventricular rupture can be observed during primary coronary angioplasty and could help physicians to adopt a more accurate echocardiographic protocol in patients with such signs in order to refer patients without delay to surgical repair.
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